THE BATTLE OF THE CLUBS.

THE BATTLE OF THE CLUBS.

1478 ’ ON THE his terms of peace and given them a week in which to credit on the sanitary and medical arrangements. Intelli. submit to them. The col...

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1478 ’

ON THE

his terms of peace and given them a week in which to credit on the sanitary and medical arrangements. Intelli. submit to them. The cold is beginning to be severe and gence from the Indian frontier regarding the campaign fixes preparations must be made for winter quarters in case of a what is to be the future programme. From the Bagh camp more prolonged occupation being necessary, and some of the as a centre detached columns will march through the country, Sikh regiments, who have done such splendid service and equipped with the lightest amount of baggage, stores, and would suffer greatly in health from the cold of a winter’s food supplies. The latest news is of a more favourable character owing to the submission of several of the Afridi campaign, are returning to India. But the strategical plan of the campaign, as we have tribes. If the remaining tribes refuse to accede to the terms understood it, does not necessarily involve our remaining in offered them the force will winter in a standing camp in the country during the winter and there are indications that suitable and specially selected position, probably near Barkai. this plan will be adhered to. It is announced that Kohat According to some accounts the position of the Ameer of will cease, or has already ceased, to be the base of opera- Afghanistan is a very difficult one, for his friendly policy tions and the Peshawar end of the Khyber Pass will take towards the Indian Government is not popular with his its place. General Lockhart’s object was to get to and pass own people or, of course, with the Afridi tribes. It is, through the Tirah and Bara valleys and then make his way to be earnestly hoped that a satisfactory settlement may be with soon arrived at, for the situation whether regarded from a towards the Peshawar border, joining General Hammond’s column advancing towards the Bara military or political point of view has grave difficulties. valley from the east from Peshawar by the Khyber route. Sir The positions taken by us cannot for sanitary, financial, and William Lockhart, in the address he gave to the troops at transport reasons be held during the winter, and when the Maidan, highly commended their bravery and devotion and troops evacuate them and return towards India it may be pointed out very frankly the great natural advantages which confidently expected that they will be subject to attacks by the tribes possessed in the kind of warfare in which they the tribesmen ; and on the other hand to undertake another were engaged from their intimate knowledge of the ground punitive campaign will be merely doing the work over again and from their skill in skirmishing and as rifle shots. He at ruinous cost. The sick and wounded are, we are glad to did this in order to inculcate the importance of discipline, learn, doing well. The commissariat and medical arrangecontrolled fire, mutual support, and the avoidance of ments during the campaign have by all accounts been very straggling. Of course he did not omit to add his assured good. confidence in the success of his force, and it is a noteworthy indication of a general’s entire belief and trust in the troops under his command that he had no misgivings THE BATTLE OF THE CLUBS. about putting the position thus plainly before them. He knew the men with whom he was dealing. The SURGEONS OF ENGLAND AND troops composing the expeditionary columns have had mostiTHE ROYAL COLLEGE laborious marches through the defiles and over mountainous MEDICAL AID ASSOCIATIONS. passes and have had to encounter a good deal of hardship’ As we reported in THE LANCET last week, Mr. W. G. due to the great diurnal variations of temperature, the hard work by day and disturbed rest at night, owing to the nightly Dickinson, the honorary secretary of the Society of Members " of the tribes, but their health of the Royal College of Surgeons of England, moved a resofiring and and spirits have remained excellent. As illustrative of the lation at the thirteenth annual meeting of the Fellows and liability of native troops from the plains of India to contract Members of the College, held on Nov. 18th last, asking the and die from respiratory diseases as compared with European Council of the College" ...... to make a clear pronouncement troops we may take the figures in the blue-book on the for the information of Fellows and Members that the acting "Sanitary Measures in Indiarecently issued. Respiratory medical as the paid officials of any by qualified practitioners diseases are the chief cause of death and in 1895 no less than 42 per cent. of all the deaths in the native army were due to institutions which tout and canvass for patients or which them. Much of the pueumonia was attributable to the allow the well-to-do classes to take advantage of rates of arranged to meet the necessities of the poor is exposure endured by the regiments on active service in in a professional respect’ and deserving of ’ disgraceful Waziristan and Chitral. The admission and death ratios Mr. Dickinson pointed out the widespread public Indus and the were highest in the the hills, and valley and professional evils induced by Medical Aid Associations percentage of pneumonia to total deaths was there also and other companies trading in medical attendance and was in hills the highest. Both in the Indus valley and to adduce examples in the procedure of other corporaable pneumonia was mo&t prevalent in the cold months, and tions in support of his resolution. The Royal College of the same was the case for India as a whole. European Physicians of Ireland had expressed disapproval of their troops suffer much less on field service than the natives, Licentiates accepting appointments to medical aid associaprobably because they are more accustomed to cold, because tions ; the Royal College of Surgeons in Ireland had on one fed. are better more and clad, Many occasion at nutritiously they rate any represented to a Licentiate the impromedical officers serving with native regiments on the frontier of with a canvassing business; and associated being are of opinion that the pneumonia is often of an infectious priety the of of London had declared Royal College Physicians type and all seem agreed that malaria-saturated or scurvytainted men exposed to chill are peculiarly vulnerable in association with institutions of this sort to be undesirable on the part of their Fellows and Members. this respect. Mr. Dickinson’s motion was carried, the President saying Some progress towards peace has been made. The Tochi if particular instances of canvassing were brought before that expedition appears to be settled, things are quiet in the Kurram, the Malakand expedition is over. the Ali the Council the cases would be considered very carefully. Khel Orakzais in Mastura Valley have submitted and are There should be no difficulty in giving the Council a good deal to consider. paying the fines imposed upon them, and Sir William Lockhart is now waiting to see the result of his proffered EASTBOURNE PROVIDENT MEDICAL terms to the Tirah tribesmen. If they are accepted, and A meeting of the medical profession in Eastbourne was according to the latest intelligence there appears to be some hope that they will be accepted, the troops will recently held to receive the second annual report of this forthwith commence their return marches to India by association. The report showed that the year had been one -

payment censure."

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columns. The "politicals"will, we feel pretty sure, try of steady progress. The number of members had grown to to effect a settlement if only to avoid the ruinous drain 4153 as against 3689 at the date of the last annual report. of a prolonged occupation on the Indian exchequer. General The total amount received in members’ payments for the Westmacott’s brigade has advanced to Duatoi after havingyear had been an increase of per cent. upon last traversed some miles of the worst defiles they have yetyear. had been distributed amongst the acting r had to cross. It may be mentioned that the Lee-Metfordtotal The working expenses higher than last year’s by bullet, as modified in India, has proved much more effective lhad been covered by a charge of something over l8 per cent. !3.S regards "stopping power" than the missile which it of the money collected. Only one instance of a family i India of Nov. 6th the financially replaced. According to the ineligible having gained admission to the associaleaths from disease in General Blood’s Malakand force tion had been brought to the notice of the committee, and Sept. 6th, including those at the base hospital at tthey were, after due inquiry, removed from membership. We had only been-British seven, native five. This (congratulate the association upon their sound work; local of this sort should have no difficulty in holding ihows how healthy the troops have been and reflects much c

1479 their own against the medical aid societies, supplying as the]y weeks ; of these, 218 resulted from measles, 97 from diphdo better attendance at much the same aggregate cost, whilEetheria, 70 from whooping-cough, 70 from "fever"(princithe money is received by the people who do the work. pally enteric), 58 from scarlet fever, and 39 from diarrhoea. No death from any of these diseases was recorded last week in Brighton, Plymouth, or Derby; in the other towns they THE WANDSWORTII PROVIDENT DISPENSARY. caused the lowest death-rates in Cardiff and Croydon and the We have received the rules of the Wandsworth Providentt highest rates in Oldham, Burnley, Halifax, and Blackburn. Dispensary, the object of which institution is "to enable! The greatest mortality from measles occurred in London, the working classes to insure to themselves and their familiesI Birmingham, Huddersfield, Oldham, Halifax, Blackburn, efficient medical advice and medicine during illness by theirand Swansea ; from scarlet fever in Burnley ; from whoopingown weekly payments, commenced in time of health, aidedl cough in Sheffield ; and from "fever" in Bristol, Preston, by the contributions of other inhabitants." There arei and Birkenhead. The 97 deaths from diphtheria included certain points about the rules which call for commendation, 63 in London, 8 in Leeds, 4 in West Ham, 4 in Burnley, and although in other respects the dispensary sins in company 3 in Manchester. No fatal case of small-pox was registered For example, under last week either in London or in any other of the thirty-three with most medical aid societies. Rule IV. the consulting medical officer, together with the large towns; and no small-pox patients were under treattreasurer and secretary, becomes an ex.o.t1icio member of the ment in any of the Metropolitan Asylum Hospitals. The Committee of Management, whose functions are to be number of scarlet fever patients in these hospitals and in "entrusted with the general management of the institution, the London Fever Hospital on Saturday last, Nov. 27th, was the appointments and dismissal of its officers and the 3818, against 3680, 3777, and 3792 at the end of the three superintendence of its financial affairs." We are glad preceding weeks ; 375 new cases were admitted during the to see that the resident medical officer, whose services week, against 339, 460, and 397 in the three preceding constitute the whole and only benefit which the dis- weeks. The deaths referred to diseases of the respiratory pensary offers to its members, will have someone of organs in London which had been 420 and 414 in the two medical knowledge to represent professional views on the preceding weeks rose again to 471 last week and were Committee of Management by which he is controlled. He 36 above the corrected average. The causes of 59, or 1-4 is himself probably in a far better position to help the Com- per cent., of the deaths in the thirty-three towns were mittee of Management than ever his consultant-colleague not certified either by a registered medical practitioner can be, but presumably he can inform that gentleman of the or by a coroner. All the causes of death were duly certified things that it is necessary for him to know. We note with in West Ham, Bradford, Leeds, Newcastle-upon-Tyne and regret that no wage limit is imposed upon the members. We in thirteen other smaller towns; the largest proportions of have reason to believe that this dispensary is well and fairly uncertified deaths were registered in Birmingham, Leicester, managed, but we would point out to those in authority over Liverpool, and Preston. its working that to have no wage limit and to seek aid from " other inhabitants " than the members is to invite abuse of HEALTH OF SCOTCH TOWNS. the charity. The annual rate of mortality in the eight Scotch towns which had been 20’1 and 18-5per 1000 in the two preceding A QUESTION OF COMPARATIVE IMPORTANCE. weeks rose again to 19’5 during the week ending A correspondent in the Isle of Man sends us the following Nov. 27th, but was 07 per 1000 below the mean rate during extract from the Isle of Man Examiraer of some weeks ago:-, the same period in the thirty-three large English towns. "The minutes of the Stores Committee [of the town council The rates in the eight Scotch towns ranged from 14’5 in of Donglas] included the following :— Leith and 17’5 in Dundee to 22’2 in Aberdeen and 25’4 in 19 resolved: That the tender of Mr. T. S. Atkinson, Finch- Greenock. The 581 deaths in these towns included 23 which road, quoting 3s. 6d. per horse per month for shoeing, were referred to whooping-cough, 22 to diarrhoea, 12 to including leathers, frosting extra, be accepted. scarlet fever, 10 to measles, 5 to diphtheria, and 2 to "fever." "Tender for supplying veterinary attendance and medicine In all, 74 deaths resulted from these principal zymotic for the ensuing year submitted and considered. Resolved : diseases, against 64 and 62 in the two preceding weeks. of T. S. Atkinson to Mr. That the tender offering supply These 74 deaths were equal to an annual rate of 2’5 per veterinary attendance and medicine for the horses for a 1000 which was slightly below the mean rate last period of twelve months at 1Is. per horse per annum, week from the same diseases in the thirty-three large examinations as to soundness to be extra, be accepted. English towns. The fatal cases of whooping-cough which "The minutes were adopted upon the motion of Councillor had declined from 16 to 10 in the three preceding weeks Cubbon, seconded by Councillor Moore." rose again to 23 last week and included 15 in Glasgow. An accompanying letter informs us that from the balance- The deaths referred to scarlet fever which had been 18, sheet of a friendly society before him he learns that "a 11, and 8 in the three preceding weeks rose again to 12 leading practitioner of the district attends members, pro- last week, of which 5 occurred in Glasgow, 3 in Dundee, vides medicine, and, if ordered, stimulants at the rate of and 2 in Edinburgh. The 10 fatal cases of measles showed 2s. 6d. per member per annum, a very small proportion of a decline of 2 from the number in the preceding week and which is levied from the members themselves." We, like included 9 in The deaths from diphtheria which Glasgow. our correspondent, are very glad that Mr. Atkinson’s services had been 6 and 4 in the two preceding weeks were 5 last are appreciated at their true worth, but the difference of which 2 were recorded in Glasgow and 2 in Edinweek, between the price paid for the medical charge of a horse and The deaths referred to diseases of the respiratory burgh. that paid for the medical charge of a man is a little sensaorgans in these towns, which had been 161 and 145 in the tional, even though the quadruped is the larger animal. two preceding weeks further declinEd to 123 last week and were 49 below the number in the corresponding week of last year. The causes of 35, or more than 6 per cent., of the deaths in these eight towns last week were not certified. ,

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VITAL STATISTICS. HEALTH OF DUBLIN. HEALTH OF ENGLISH TOWNS.

IN

thirty-three

largest English towns 6409 births registered during the week ending The annual rate of mortality in these had been 19-0 and 18per 1000 in the two

and 4258 deaths

Nov. 27th.

of the

were

towns which preceding weeks rose again last week to 202. In London the rate was 21-0 per 1000 while it averaged 19-7 in the thirty-two provincial towns. The lowest rates in these towns were 11’0 in Cardiff, 12-5 in Croydon, 13’1 in Portsmouth, and 15 5 in Hull ; the highest rates were 23-7 in Sheffield, 24-1 in Barnley, 28-2 in Oldham, and 28-6 in Swansea. The 4258 deaths included 552 which were referred to the principal zymotic diseases, against 461 and 462 in the two preceding

The death-rate in Dublin which had been 19and 23’3 per 1000 in the two preceding weeks further rose to 254 during the week ending Nov. 27th. During the past eight weeks of the current quarter the death-rate in the city has averaged 23’2 per 1000, the rate during the same period being 18-0 in London and 18-8 in Edinburgh. The 170 deaths registered in Dublin during the week under notice showed an increase of 14 upon the number in the preceding week and included 20 which were referred to the principal zymotic diseases, against 24 and 10 in the two preceding weeks ; of these, 12 resulted from " fever " (principally enteric), 4 from diarrhoea, 3 from scarlet fever,1 from whooping-cough, and not one either from